RESEARCH - Sonographic detected joint effusion compared to physical examination in the assessment of sacroiliac joint in spondyloarthritis

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Ann Rheum Dis. Published Online First: 28 October 2008.

doi:10.1136/ard.2008.093351

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Extended Report

Sonographic detected joint effusion compared to physical examination

in the assessment of sacroiliac joint in spondyloarthritis

Spadaro 1*, maria Iagnocco 1, Giacomo Baccano 1, Fulvia

Ceccarelli 1, Emanuela Sabatini 1 and Guido Valesini 1

1 Divisione di Reumatologia - " Sapienza " - Università di Roma, Italy

Abstract

Objective: We designed an observational case-control study to analyse

the discriminative value of ultrasound (US) detected joint effusion

compared to physical examination in the assessment of sacroiliac

joints (SIJ) in patients with spondyloarthropathy (SpA) with or

without inflammatory back pain (IBP).

Methods: We studied 45 patients with SpA, classified according to

European Spondylarthropathy Study Group criteria and 30 healthy

volunteers. In all patients clinical evaluation of the SIJ, BASMI,

BASDAI, BASFI, HAQ, patient's and physician's VAS on global disease

activity were performed. US examinations were performed by Agilent HP

Image Point Hx machine equipped with a linear probe (7.5 MHz).

Results: US showed joint effusion in 38.9% SIJ of patients with SpA

and in 1.7% SIJ of the controls (p<0.0001). The presence of IBP was

significantly associated with SIJ effusion assessed by US alone or

plus at least one SIJ test. SIJ effusion assessed by US alone or plus

at least one SIJ test had a positive likelihood ratio (LR) (2.67 and

4.04 respectively) for the presence of IBP higher than LR of single

clinical tests. Positive sacral sulcus test, iliac gapping and midline

sacral thrust test were associated with SIJ effusion assessed by US,

but all clinical tests, singly and in various combinations, had a low

LR for the presence of SIJ effusion assessed by US.

Conclusions: Our study suggests that high resolution sonography is

useful in the assessment of SIJ involvement in SpA, resulting in

images that are fast and inexpensive and may locate, complementing the

physical examination, the origin of IBP.

http://ard.bmj.com/cgi/content/abstract/ard.2008.093351v1?papetoc

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